Chemotherapy are drugs which have been studied carefully and determined to have benefit in destroying cancer cells, though often at the expense of having side effects on the body. Chemotherapy drugs can be given several ways: by mouth, by injections in a vein (IV), by injection into the muscle (IM, or a "shot), under the skin (sub Q), and by spinal tap (IT). These anti-cancer drugs are given at specific times to optimally kill the cancer cells. It can be expected that some normal cells will also be damaged. Normal cells which replace themselves rapidly, such as those of hair, mouth, intestines, and bone marrow, are most often affected by drug treatment. This normal cell damage is one of the "side effects" of chemotherapy. The physician must maintain a balance in favor of killing most cancer cells and doing the least harm to normal cells.

The physician will discuss the treatment plan for your child with you. He/she will answer any questions you may have about the treatment and the possible side effects. The side effects may vary from child-to-child. (This is also true of radiation therapy). The physician can give you the general trends that have been observed in other children.

The following is a list of the chemotherapy drugs that may be given prior to bone marrow transplant. The actual days the chemotherapy is given may differ depending on the protocol your child is on.

VP-16
VP-16 is a chemotherapeutic agent which is given as an IV infusion. The dose determines the length of infusion, but this can vary from 1 hour - 8 hours. The major side effect is a rapid drop in blood pressure, and therefore, your child will require frequent blood pressure monitoring throughout the infusion. Generally, there is no nausea with this drug. Other side effects include diarrhea, mouth sores, alopecia (hair loss) and GI bleeds.

Ara-c
Ara-c is a chemotherapeutic medication given IT (in the spinal fluid) and IV in therapy. The IT infusion will be a procedure done by the physician or physician assistant. A spinal needle is inserted by the medical staff and the chemo is slowly pushed in. This is done to prevent central nervous system (CNS) relapse.

For the IV infusion, Ara-c is usually given over three hours. Side effects caused by Ara-c include nausea and vomiting, mouth sores, GI bleeding, hair loss and dry eyes. Special eye drops are given to prevent the side effects of dry eyes.

Cytoxan
Cytoxan is a chemotherapeutic medication that is usually given as a one hour infusion. Cytoxan has the potential for causing cardiac problems, so a baseline EKG is ordered before the first dose. If problems are discovered, further EKGs will be ordered. Also, before the first dose of cytoxan, a Foley catheter may need to be inserted to ensure good urine output and minimize the risk of getting hemorrhagic cystitis (bleeding in the bladder), a major side effect of this drug.

Medications such as B & O suppositories and pyridium can be given to patients who develop bladder spasms with the Foley catheter. If there are no problems with blood in the urine, the Foley will be removed 24 hours after the last dose of Cytoxan. Other side effects of Cytoxan include nausea and vomiting, hair loss, GI bleeding, mouth ulcers, and infertility.

Busulfan
Busulfan is an oral chemotherapeutic medication. This is given in the form of small, white pills. If a patient cannot take the pills by mouth, the pills can be put into capsules or they can be crushed and mixed with water and given by a nasogastric tube. Busulfan is usually given every six hours for 16 doses. Busulfan can cause seizures and sometimes patients will need to take dilantin, an anti-seizure medication, while they are getting busulfan to prevent seizures from occurring. Because of this seizure potential, dilantin (an anti-seizure medication) will be ordered before the first busulfan dose. If the patient has a history of seizures, seizure precautions such as padded side rails will be used. Other side effects include lung injury (fibrosis), GI bleeds, and leaky capillary syndrome.

Thiotepa
Thiotepa is a chemotherapy medication given IV over three hours. Thiotepa may cause nausea, vomiting, skin irritation, mucositis and headaches.

Thiotepa is released through the skin and may cause skin irritation (especially through the groin, armpit area and neck). For this reason, patients receiving thiotepa must take three baths each day beginning with the first dose of thiotepa and for 48 hours after the last dose. Your child must take one shower or tub bath and the other two may be sponge baths. The sponge bath should be with water only. Hibiclens should be included with the shower/bath.

Do not use creams or lotions on the skin during the time the thiotepa is given. Avoid tape on the skin. Do one central line dressing change each day thiotepa is given.

Melphalan
Melphalan is a chemotherapy medication that may be given prior to transplantation. Melphalan is given IV over a short period of time (20-30 minutes). Melphalan may cause nausea, vomiting diarrhea, and severe mucositis with painful mouth sores. Melphalan may also cause liver damage.

Methotrexate
Methotrexate is a chemotherapy agent usually given IV over four hours. Leucovorin is given following high dose methotrexate to lessen some of the side effects of methotrexate, such as mouth and intestinal sores.

IV fluids are given following the administration of methotrexate and continue for 3-4 days. Blood samples are drawn to check the level and clearance of methotrexate. Urine output is closely monitored. The rate of the IV fluid may have to be increased to maintain urine output. The acidity of the urine is also checked and additional medication (sodium bicarbonate) may need to be given.

Low doses of methotrexate may also be given as part of a protocol to prevent graft-versus-host disease. These low doses rarely cause problems, but if the patient already has severe mucositis, methotrexate doses may be decreased or deleted.

Carboplatin
Carboplatin is a chemotherapy medication usually given IV over two hours, continuously over 24 hours.

Carboplatin may cause nausea and vomiting. Additional side effects include hearing loss, decreased kidney function, loss of electrolytes (sodium, magnesium, potassium and calcium) and decreased liver function. An allergic reaction may occur, but this is very rare.

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